Fewer Eggs, More Problems

Most people know that fertility declines with age. Chances of pregnancy start to drop off in the early 30s, but the decline occurs much more rapidly after 35 years of age. However, some women can experience a diminished egg supply much earlier in life. Formally known as diminished ovarian reserve (DOR), this diagnosis is made when the number of eggs in the ovaries is fewer than expected for the patient’s age. Women with DOR can have a harder time becoming pregnant and may require fertility treatment to have a baby.


Making the diagnosis

If a couple has been trying to get pregnant for 1 year without success, additional testing to evaluate fertility will be ordered. In some cases, women planning to delay pregnancy may order fertility testing to determine whether there is a need to freeze eggs proactively. Bloodwork can check hormone and vitamin levels to ensure everything is within range. Diminished ovarian reserve testing can be ordered to evaluate the number of eggs remaining. The DOR test measures anti-mullerian hormone (AMH) levels, follicle-stimulating hormone (FSH), and estradiol. These results are combined with the findings from a vaginal ultrasound, which measures ovarian volume and number of follicles present, to make a diagnosis.

Treatment with IUI

Some women with a DOR diagnosis prefer to continue trying naturally for a while, as pregnancy is still possible. However, if a baby is desired more urgently or the woman is of advanced maternal age (AMA), then moving on to fertility treatment may be recommended. Intrauterine insemination (IUI) is a fertility treatment that involves injecting a concentrated sperm sample directly into the uterus. For women with DOR, this approach doesn’t help much since there may be no egg released for the sperm to connect with. In some cases, ovarian stimulant medications can be used to increase the likelihood of the body producing an egg during the IUI cycle, but chances of success are still low.

Moving on to IVF

In most cases, the doctor will recommend IVF for women with DOR. With IVF, the patient is given medication to stimulate the growth of multiple eggs in the ovaries. The eggs are then retrieved and can be either combined with sperm to create an embryo or stored for future use. A recent study found that the success rate of IVF treatment for women with DOR was around 11.5% per cycle. This means that multiple retrievals and transfers may need to be performed before a pregnancy is achieved with diminished ovarian reserve.

Considering egg donation

If IVF is unsuccessful, another option available to women with DOR is egg donation. In this scenario, a donor provides the egg, and the woman’s partner can supply a sperm sample. Using IVF, the 2 are combined to create an embryo. Although the child will not be genetically related to the woman, this approach allows the patient to experience pregnancy and have a child. Adoption is another option that can be considered should IVF fail.


Women with DOR can benefit most from IVF. Although not guaranteed, IVF is the best ART approach to achieve a pregnancy when eggs are in limited supply. A low egg count can feel stressful, but a baby is still possible with advances in reproductive technology.

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